Tuberculosis and malaria walk side by side in the Brazilian Amazon: an ecological approach.

OBJECTIVE: To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio-economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015. METHODS: Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate. RESULTS: Positive associations of overall malaria (ß = 0.100 [CI = 0.032, 0.168], P = 0.004), P. vivax malaria (ß = 0.115 [CI = 0.036, 0.195], P = 0.005), and P. falciparum malaria (ß = 0.389 [CI = -0.0124, 0.791], P = 0.057) with TB rates were found, regardless of the sociodemographic factors included in the study. CONCLUSION: In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co-infections also occur in this region, regardless of the HIV status.

OBJECTIF: Evaluer la distribution spatiale de l'incidence de la tuberculose (TB) et du paludisme, ainsi que leur association spatiale, indépendamment des facteurs environnementaux et socioéconomiques communément rapportés comme déterminants des taux des deux maladie dans les municipalités de l'Etat d'Amazonas, au Brésil, entre 2012 et 2015. MÉTHODES: Dans le cadre d'une approche écologique prenant en considération les municipalités d'Amazonas, au Brésil, comme unité d'analyse, un modèle de régression binomiale négatif a été utilisé pour évaluer l'association entre les taux de paludisme et de TB, dans laquelle la variable dépendante était le taux moyen d'incidence municipale de la TB. RÉSULTATS: Des associations positives entre le paludisme en général (ß = 0,100 [IC= 0,032 à 0,168], p = 0,004), le paludisme à P. vivax (ß = 0,115 [IC: 0,036 à 0,195], p = 0,005) et le paludisme à P. falciparum (ß = 0,389 [IC: - 0,0124 à 0,791], p = 0,057) avec des taux de TB ont été retrouvées quels que soient les facteurs sociodémographiques inclus dans l'étude. CONCLUSION: En Amazonie brésilienne, la TB et le paludisme sont associés spatialement. Par conséquent, il est très probable que des coinfections se produisent également dans cette région, quel que soit le statut VIH.

Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV.

OBJECTIVE: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. METHODS: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. RESULTS: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). CONCLUSIONS: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil: Understanding losses in the latent tuberculosis cascade of care.

INTRODUCTION: Tuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment. However, many losses occur in the different steps of the contacts' cascade of care. Reasons for this are poorly understood. OBJECTIVE: To describe the different steps where losses in the contact cascade occur and to explore knowledge and attitudes regarding tuberculosis transmission/prevention and perceptions about tuberculosis services in order to understand the reasons for losses from the tuberculosis service users' perspective. DESIGN: We collected routine data from the index case and contact registry books and from patients' records to build the cascade of care of contacts in 12 health facilities in three Brazilian cities with high tuberculosis incidence rates. During a knowledge, attitudes and practices (KAP) survey, trained interviewers administered a semi-structured questionnaire to 138 index cases and 98 contacts. RESULTS: Most of the losses in the cascade occurred in the first two steps (contact identification, 43% and tuberculin skin testing placement, 91% of the identified contacts). Among KAP-interviewed contacts, 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services. CONCLUSION: Only a small proportion of contacts are evaluated for active and latent tuberculosis, despite their-and their index cases'-reasonable knowledge, positive attitudes towards prevention and satisfaction with tuberculosis services. In these services, education of service users would not be a sufficient solution. Healthcare workers' and managers' perspective, not explored in this study, may bring more light to this subject.

Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV / Preditores de mortalidade em pacientes da unidade de terapia intensiva coinfectados por tuberculose e HIV

ABSTRACT Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

RESUMO Objetivo: Identificar fatores preditores de mortalidade em pacientes da UTI coinfectados por tuberculose (TB)/HIV em Manaus (AM). Métodos: Estudo retrospectivo de coorte com pacientes coinfectados por TB/HIV, com mais de 18 anos de idade e admitidos na UTI entre janeiro de 2011 e dezembro de 2014. Foram avaliadas variáveis sociodemográficas, clínicas e laboratoriais. Para identificar fatores preditores de mortalidade, foi empregado um modelo de riscos proporcionais de Cox. Resultados: Durante o período estudado, 120 pacientes com coinfecção por TB/HIV foram admitidos na UTI. A média de idade foi de 37,0 ± 11,7 anos. Dos 120 pacientes avaliados, 94 (78,3%) morreram; dos 94 óbitos, 62 (66,0%) ocorreram na primeira semana após a admissão. Havia dados sobre ventilação mecânica invasiva (VMI) e SARA referentes a 86 e 67 pacientes, respectivamente. Dos 86, 75 (87,2%) foram submetidos a VMI, e, dos 67, 48 (71,6%) apresentaram SARA. Os fatores que se relacionaram independentemente com a mortalidade foram VMI (p = 0,002), hipoalbuminemia (p = 0,013) e contagem de CD4 < 200 células/mm3 (p = 0,002). Conclusões: Elevada mortalidade precoce foi observada em pacientes com coinfecção por TB/HIV admitidos na UTI. Os fatores preditores de mortalidade nessa população foram VMI, hipoalbuminemia e imunodepressão grave.

Desenvolvimento de um website educacional para o ensino do processo de enfermagem em cardiologia / Development of an educational website to teach cardiology in the nursing process

Objetivo: descrever o processo de criação de um Website educacional para acadêmicos e profissionais enfermeiros contendo informações sobre o Processo de Enfermagem em Cardiologia. Metodologia: pesquisa experimental descritiva, baseada no modelo teórico de Tronchim para a construção de Website, composta das fases de conceitualização, desenvolvimento, implementação e avaliação. Resultados: o site possui 50 páginas contendo informações, orientações, fotos e ilustrações, estruturadas em tópicos com os conceitos básicos da anatomia e fisiologia cardíaca, coleta de dados, diagnósticos de enfermagem, planejamento, implementação e avaliação. Conclusão: a criação e desenvolvimento do Website foram descritos, podendo ser acessados no www.webcardio.net.br, na opção pesquisa.

Objective: To describe the process of creating an educational website for nursing and professional academics with information on the Nursing Process in Cardiology. Methodology: descriptive experimental research, based on the theoretical model of Tronchim to build websites, consisting of stages of conceptualization, development, implementation and evaluation. Results: The site has 50 pages containing information, directions, photos and illustrations, structured topics with the basics of anatomy and cardiac physiology, data collection, nursing diagnosis, planning, implementation and evaluation. Conclusion: the creation and development of the website have been described and can be accessed at www.webcardio.net.br the search option.

Objetivo: Describir el proceso de creación de un sitio web educativo para enfermeras académicos y profesionales con información sobre el Proceso de Enfermería en Cardiología. Metodología: la investigación experimental descriptivo, basado en el modelo teórico de Tronchim para construir sitios web, que consiste en las etapas de conceptualización, desarrollo, implementación y evaluación. Resultados: el sitio tiene 50 páginas que contienen información, direcciones, fotos e ilustraciones, temas estructurados con los fundamentos de la anatomía y la fisiología cardiaca, la recopilación de datos , diagnóstico de enfermería, planificación, ejecución y evaluación. Conclusión: la creación y desarrollo de la página web se han descrito y se puede acceder en www.webcardio.net.br la opción de búsqueda.